Provider Demographics
NPI:1265721492
Name:PHEASANT HILL, LLC
Entity type:Organization
Organization Name:PHEASANT HILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-383-5627
Mailing Address - Street 1:1308 SW COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2756
Mailing Address - Country:US
Mailing Address - Phone:785-383-5627
Mailing Address - Fax:
Practice Address - Street 1:1308 SW COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2756
Practice Address - Country:US
Practice Address - Phone:785-383-5627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200688280A251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services